Philosophy of Psychiatry

It is a mistake to think that any philosophical contribution to the study of psychopathology is otiose. I identify three non-exhaustive roles that philosophy can and does occupy in the study of mental disorder, which I call the agenda-setting role, the synthetic role, and the regulative role. The three roles are illustrated via consideration of the importance of Jaspers’ notion of understanding and its application to specific examples of mental disorder, including delusions of reference, Capgras delusion and other monothematic delusions, (...) and clinical depression. Together the three roles assign to philosophy of psychopathology the task of determining how to situate the varieties of mental disorder within the system of interpretive and evaluative concepts that partially make up the dynamic but indispensable manifest image. (shrink)

In this article, I explore Seth Farber’s critique in _The Spiritual Gift of Madness_ that the leaders of the Mad Pride movement are failing to realize his vision of the mad as spiritual vanguard of sociopolitical transformation. First, I show how, contra Farber’s polemic, several postmodern theorists are well suited for this leadership (especially the Argentinian post-Marxist philosopher Ernesto Laclau). Second, I reinterpret the first book by the Icarus Project, _Navigating the Space between Brilliance and Madness_, by reimagining its central (...) metaphor of Icarus in the context of late capitalism as a prison world. Finally, I conclude with four strategies derived therefrom for higher functioning mad leaders to transform our penitentiary world. (shrink)

In this paper, I draw on phenomenological analyses of religious voice-hearing and related experiences to elucidate the role of phenomenology in discerning benign from pathological religious experience. First, I present phenomenological discontinuities between cases of benign and pathological voice-hearing by drawing on a study of first-person accounts of voice-hearers within the Pentecostal movement which evinces that voice-hearing is not inherently pathological. Second, I introduce the epidemiological continuity of psychotic-like phenomena by drawing on a study of the contextual and responsive differences (...) between clinical and non-clinical voice-hearers which point to the contexts wherein voice-hearing does not lead to pathology. Third, I present a successful case where the meaning of the anomalous experiences is validated and normalized by drawing on studies of mediumistic experience which illuminate its therapeutic benefits. Finally, I argue that failing to take the voice-hearer’s lived experience into account in the diagnostic moment can result in the pathologization of benign experiences. (shrink)

Le controversie nosologiche in psichiatria siano orientate da ragioni sia epistemiche che non epistemiche, da questioni di evidenza ma anche di etica e sociologia della scienza, data la presenza di vari programmi di ricerca, di metodologie e anche di agenti differenti che si focalizzano sul problema del disturbo mentale. I due casi qui brevemente considerati, quello della Disposofobia e quello del Disturbo di personalità narcisistica mostrano, assieme al ruolo dell’evidenza empirica, da un lato il peso delle ragioni etiche dei gruppi (...) di pazienti e di quelle culturali della società allargata, dall’altro le dinamiche del consenso tra esperti. Che i disturbi mentali siano o non siano generi naturali, la loro classificazione è un processo razionale complesso che comprende norme e deviazioni dalle norme di diverso tipo. (shrink)

Literature on epistemic injustice has grown tremendously as an increasingly rich and diverse body of work in recent years. From the point of view of intercultural and anticolonial discussions, contemporary contributions have also helped to illuminate how epistemic injustice and other forms of cultural domination might be related to essential processes within the structures of colonial and racial supremacy. -/- This proposal aims to contribute to such relevant and illuminating discussions by focusing on the role that language and culture might (...) have in phenomena of epistemic injustice, particularly, hermeneutical injustice. Despite the central role played by semantics in epistemic injustice studies, the question about whether certain languages could also themselves be the recipients of epistemic injustice has been rather undertheorized. Simultaneously, recent movements to advocate for minority language rights, such as the Linguistic Human Rights Movement (LHR), raise important questions in this connection. -/- In the present paper, I argue that attending to the intercultural context reveals a new sort of hermeneutical injustice, one that, surprisingly, has never been articulated before. In particular, I am referring to a kind of HI that is essentially “linguistic” and “culture-specific”. I will be presenting two different subtypes for this kind of hermeneutical injustice: The first concerns the possibility of considering certain languages themselves as genuine objects of hermeneutical injustice,while the second has to do with certain specific culturally-established expressions or forms of talking. (shrink)

This paper provides a historical analysis of a shift in the way animal models of mental disorders were conceptualized: the shift from the mid-twentieth-century view, adopted by some, that animal models model syndromes classified in manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), to the later widespread view that animal models model component parts of psychiatric syndromes. I argue that in the middle of the twentieth century the attempt to maximize the face validity of animal models (...) sometimes led to the pursuit of the ideal of an animal model that represented a behaviorally defined psychiatric syndrome as described in manuals such as the DSM. I show how developments within psychiatric genetics and related criticism of the DSM in the 1990s and 2000s led to the rejection of this ideal and how researchers in the first decade of the twenty-first century came to believe that animal models of mental disorders should model component parts of mental disorders, adopting a so-called endophenotype approach. (shrink)

Paperwork plays a key role in a how institutions accommodate, refuse, or manage disabled people. This article develops modes for reading paperwork that build on each other, beginning with (a) recognizing the institutional pressures at work in shaping bureaucratic practices, then (b) considering how a person's relationship to disability influences how they might encounter these practices, and ultimately (c) noticing how the encounter between disabled/mad people and an institution might create something new, what the author calls archival excess. These methods (...) for reading are in conversation with disability studies, medical humanities, and document studies, and ultimately work toward a goal adapted from the principles of Disability Justice: recognizing the wholeness of disabled subjects in institutional archives. (shrink)

The mid-century object relations approach saw the category of schizoids as crucial to its own formation. Rooted in a developmental phase where the perception of the mother as a whole and real person had not yet been secured, the schizoid constitution impeded relationships and forced schizoids to communicate through a compliant persona while the kernel self remained isolated. Fairbairn, Winnicott, and Guntrip thought that schizoid features underlay many other pathologies that earlier, Freudian psychoanalysis had misidentified. To correct this, a move (...) to the attachment-oriented theory was necessary, triggering the development of the object relations perspective as a distinct and independent approach. While playing this role in the development of object relations theory, the schizoid category also attracted a note of disapproval. Fairbairn, Winnicott, and Guntrip described schizoids as harmful to society through their everyday actions and through the ideas they propagated. This judgemental nuance highlights an aspect of the alliance between object relations theory and the contemporary welfare state ideology. Culminating in the Beveridge plan, that ideology framed citizenship as comprehensive engagement with society on multiple levels. Citizenship was not just a political activity but also a personally rewarding one, as it allowed expression to each person’s wishes in ways that benefited others. Inability to engage and be rewarded in this way marked obstinate classes and produced rigid and conservative ideologies that opposed the welfare state. Object relations theory described the schizoid condition along similar lines and castigated its consequences for similar reasons. (shrink)

Realists about mental disorder have been hasty about dismissing social explanations of how mental disorder is constituted. However, many social ontologies are realist ontologies. In order to create a meaningful distinction between realism and social metaphysics about mental disorder, I propose that realism about mental disorder is best understood as Individual Trait Realism (ITR) about them. For ITR, mental disorders exist in virtue of traits. I defend the view that ITR is compatible with social metaphysics, arguing that, in asking whether (...) constituents in the social sphere figure the metaphysics of psychopathology, we are asking questions on three different strata of explanation: the strata of demarcation, instantiation, and individual traits. Distinguishing between these strata allows for nuanced realism that need not reject the social constitution of mental disorder. (shrink)

This paper contributes to the debate in the philosophy of psychiatry regarding the relation between thought insertion in schizophrenia and the sense of selfhood. Some scholars have suggested that thought insertion presents a case where the sense of selfhood is lacking. Other scholars have disputed this by proposing that a form of minimal selfhood is a necessary feature of consciousness that is still present in thought insertion, albeit in a disturbed manner. Herein, I argue that the notion of minimal selfhood (...) that is used by these scholars is ambiguous between two meanings. The first is an ontological notion concerning the first-person individuation of consciousness. The second is a phenomenological notion concerning how a conscious experience is experienced as being given to the first-person subject. I argue that the former ontological notion is indeed a necessary feature of conscious experience, but the latter phenomenological notion is only a contingent feature. Therefore, even if it is possible that thought insertion presents a case where the feeling of first-person givenness is lacking or disturbed, the first-person individuation of consciousness remains present and undisturbed. As well as further clarifying the connection between consciousness and selfhood, this philosophical analysis reveals the extent to which schizophrenia can and cannot be said to comprise a disorder of selfhood. (shrink)

Introduction to The Oxford Handbook of Phenomenological Psychopathology.

In this chapter, I introduce phenomenology and phenomenological psychopathology by clarifying the kind of implicit experiences that phenomenologists are concerned with. In section one, I introduce the phenomenological concept of pre-reflective experience, focusing especially on its relation to the concept of implicit experience. In section two, I introduce the structure of pre-reflective self-consciousness, which has been studied extensively by both classical phenomenologists and contemporary phenomenological psychopathologists. In section three, I show how phenomenological psychopathologists rely on an account of pre-reflective self-consciousness (...) to better understand the experience of schizophrenia and I outline some of the methodological challenges that arise in this field of research. This introduction should facilitate critical engagement and collaboration between phenomenologists and researchers working across a variety of disciplines, including psychology, psychiatry, the cognitive sciences, and analytic philosophy of mind. (shrink)

The Heythrop Journal, Volume 63, Issue 2, Page 315-316, March 2022.

Our main objective is to locate and analyze some philosophical issues about the concept of mental illness and the manner it is used, especially in contemporary psychiatry. It is even difficult to find a standard meaning in the main psychiatric textbooks; and, when there is some exposition of the concept, it is sparse, uncritical and vague. As an immediate consequence of these issues, practical guidelines and protocols for the clinic arise, which become almost “automatic”, unreflective behaviors, practices translated as health (...) interventions and public mental health policies. An example is the problem of overdiagnosis, in which the use of medical technology (categories, drugs, clinical exams, etc.) has generated more harm and risks to the subject's health than benefits. Exposing these issues from a philosophical perspective can eventually contribute to the field of mental health. For this work, the main manuals and textbooks of psychiatry were selected to analyze how they deal with the concept of mental illness or disorder, in addition to locating the present discussion in authors from both philosophy and the psychiatric field and how they contribute to its clarification. (shrink)

The professional application of ethics often lacks the necessary conceptual tools to construct adequate theoretical foundations that can be used for practical enterprise. This book focuses on an anthropological approach to mental illness, describing how schizophrenia can distort one's experience of empathy and of the presence in the world through pathological indifference. It describes factual and phenomenological perspectives on a case of schizophrenia, based on the method of Eugène Minkowski.

This thesis develops a novel framework for explaining delusions. In Chapter 1, I introduce the two fundamental challenges posed by delusions: the evidence challenge lies in explaining the flagrant ways delusions flout evidence; and the specificity challenge lies in explaining the fact that patients’ delusions are often about a few specific themes, and patients rarely have a wide range of delusional or odd beliefs. In Chapter 2, I discuss the strengths and weaknesses of current theories of delusions, which typically appeal (...) to one or both of two factors: anomalous experience and reasoning abnormality. I argue that anomalous experience can help explain the specificity of delusions, but has difficulties in addressing the evidence challenge; reasoning abnormality can help address the evidence challenge, but has difficulties in explaining the specificity of delusions. This suggests that there may be an important factor that has not been captured by current theories of delusions. To search for this missing factor, in Chapter 3, I turn to normal believing. Inspired by the literature on Cartesian clarity and phenomenal dogmatism, I develop a dual-force framework of believing, according to which beliefs can be understood as the results of the interaction between the justificatory force and causal force of evidence and the justificatory force and causal force of clear experience, in which something clearly seems to be so to the subject. This framework suggests that the missing factor may be the clear experience with its distinctive phenomenal clarity that compels assent. In Chapter 4, I return to delusions, and argue that the dualforce framework can help us to get a better grip on some personal descriptions of delusions; make progress in addressing the evidence and specificity challenges of delusions; and shed new light on the underpinnings of delusions. In the end, I conclude with some remaining questions for future study. (shrink)

Currently, anomalous lived temporality is not included in the main diagnostic criteria or standard symptom checklists. In this article, we present the Transdiagnostic Assessment of Temporal Experience, a structured interview that can be used by researchers and clinicians without a comprehensive phenomenological background to explore abnormal time experiences in persons with abnormal mental conditions regardless of their diagnosis. When extensive data gathered by this scale are available, it will be possible to delineate well-defined anomalous lived temporality profiles for each psychopathological (...) disorder. This instrument may also prove useful for clinicians by providing a more refined assessment of relevant psychopathological symptoms and an in-depth understanding of the patient’s abnormal behaviour as related to specific types of time experience. In the first part of the article, we provide a brief overview of the phenomenological concept of temporality, including pre-phenomenal and phenomenal time, synthesis, conation and synchronization, and of abnormal time experiences in persons affected by psychopathological conditions. In the following part, we describe the basic structure of the interview that comprises seven categories corresponding to the abnormal features of lived temporality: anomalies of synchrony, of time structure, of implicit time flow, of explicit time flow, and anomalous experiences of the past, the present and the future. The paper also includes a section on administration and scoring of the TATE scale, the complete interview and a Likert table for quantifying the frequency, intensity and interference with daily life of the phenomena explored. (shrink)

Naturalistic accounts of mental disorder aim to identify an objective basis for attributions of mental disorder. This goal is important for demarcating genuine mental disorders from artificial or socially constructed disorders. The articulation of a demarcation criterion provides a means for assuring that attributions of 'mental disorder' are not merely pathologizing different forms of social deviance. The most influential naturalistic and hybrid definitions of mental disorder identify biological dysfunction as the objective basis of mental disorders: genuine mental...

In this paper I discuss Wakefield’s account of mental disorder as applied to the case of gender dysphoria (GD). I argue that despite being a hybrid account which brings together a naturalistic and normative element in order to avoid pathologising normal or expectable states, the theory alone is still not extensive enough to answer the question of whether GD should be classed as a disorder. I suggest that the hybrid account falls short in adequately investigating how the harm and dysfunction (...) in cases of GD relate to each other, and secondly that the question of why some dysfunction is disvalued and experienced as harmful requires further consideration. This masks further analysis of patients’ distress and results in an unhelpful overlap of two types of clinical patients within a diagnosis of GD; those with gender-role dysphoria and those with sex dysphoria. These two conditions can be associated with different harms and dysfunctions but Wakefield’s hybrid account does not have the tools to recognise this. This misunderstanding of the sources of dysfunction and harm in those diagnosed with GD risks ineffective treatment for patients and reinforcing the very same prejudiced norms which were conducive to the state being experienced as harmful in the first place. The theory needs to engage, to a surprising and so far unacknowledged extent, with sociological concepts such as the categorisation and stratification of groups in society and the mechanism of systemic oppression, in order to answer the question of whether GD should be classed as a mental disorder. Only then can it successfully avoid pathologising normal or expectable states, as has been seen in past ‘illnesses’ such as homosexuality and ‘drapetomania’. (shrink)

In this chapter we discuss the role of conscious and unconscious inference in theories of delusion formation. Two competing accounts aim to shed light on the formation of delusions: according to explanationism, the delusional belief is offered as an explanation for anomalous experience; according to the endorsement theory, the delusional belief is an acknowledgement that the anomalous experience is veridical. Whereas explanationists argue that the delusional belief is inferred from experience, endorsement theorists argue that there need be no inference from (...) the experience to the delusional belief. Here we put pressure on the idea that the two accounts can be distinguished on the basis of whether inference is involved in delusion formation and argue that they are both compatible with the increasingly influential idea that Bayesian inference is responsible for the adoption of the delusional belief. One of the models of delusion formation focusing on Bayesian inference is the Coltheart model (Coltheart, Menzies, and Sutton, 2010) which we discuss in detail in the chapter. We show that, given its features, the model does not fit neatly under either explanationism or the endorsement theory. (shrink)

Introduction to the book symposium “THE BIOPSYCHOSOCIAL MODEL OF HEALTH AND DISEASE: NEW PHILOSOPHICAL AND SCIENTIFIC DEVELOPMENTS BY DEREK BOLTON AND GRANT GILLETT”.

“The addict” is a well-known figure in philosophy, but analytical attempts to define “addictive disorder” are rare. According to extant views, the “hallmark” of addiction lies in an individual’s inability or impaired ability to control the behavior the individual is addicted to doing. But how exactly are we to understand the relevant concept of (in)ability (or impaired ability) in the first place? Furthermore, what else is necessary for an individual to have an addictive disorder? I argue for a definition of (...) “addictive disorder” in terms of desire, tolerance and withdrawal, inability, and harm. The main focus of this paper is on the concept of ability. The view I propose integrates insights from the literature on abilities and develops them further as they are relevant to addiction. The resulting view offers a more differentiated perspective on questions about what individuals with an addictive disorder can and cannot do. (shrink)

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of Autism Spectrum Disorder. This (...) opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

Major Depressive Disorder (MDD) is a serious condition with a large disease burden. It is often claimed that MDD is a “brain disease.” What would it mean for MDD to be a brain disease? I argue that the best interpretation of this claim is as offering a substantive empirical hypothesis about the causes of the syndrome of depression. This syndrome-causal conception of disease, combined with the idea that MDD is a disease of the brain, commits the brain disease conception of (...) MDD to the claim that brain dysfunction causes the symptoms of MDD. I argue that this consequence of the brain disease conception of MDD is false. It incorrectly rules out genuine instances of content-sensitive causation between adverse conditions in the world and the characteristic symptoms of MDD. Empirical evidence shows that the major causes of depression are genuinely psychological causes of the symptoms of MDD. This rules out, in many cases, the “brute” causation required by the brain disease conception. The existence of cases of MDD with non-brute causes supports the reinstatement of the old nosological distinction between endogenous and exogenous depression. (shrink)

Prosper Lucas (1808–1885) is a unique figure in the history of psychiatric genetics. A physician-alienist, he authored one of the most important books on human genetics in the mid-19th century cited frequently by Darwin: the 1,500 page treatise—Philosophical and Physiological Treatise on Natural Heredity (1847–1850). This book contained a novel theory of the nature of inheritance and a detailed review of the heredity of a range of human traits and disorders, including various forms of insanity. Lucas postulated four forms of (...) heredity (direct, crossed, indirect, and atavistic), supported the importance of hereditary factors in insanity, accepted the inheritance of acquired characteristics, considered it important to examine both ancestors and collateral relatives, and recognized that heredity could influence both primary insanity and insanity secondary to other medical conditions. He reviewed the then available literature on most major forms of insanity including separate sections on hallucinations and suicidal monomania. The literature consisted of case reports of unusual families with high concentrations of illness. Lucas advocated for the homogeneity of transmission of forms of illness in families but recognized that—just as the form of illness could evolve within individuals over time—it could change forms when transmitted between relatives. (shrink)

When interacting with other people, we assume that they have their reasons for what they do and believe, and experience recognizable feelings and emotions. When people act from weakness of will or are otherwise irrational, what they do can still be comprehensible to us, since we know what it is like to fall for temptation and act against one’s better judgment. Still, when someone’s experiences, feelings and way of thinking is vastly different from our own, understanding them becomes increasingly difficult. (...) Delusions and psychosis are often seen as marking the end of intelligibility. In this paper, I argue first for the importance of seeing other people as intelligible as long as this is at all possible. Second, I argue, based on both previous literature and my own lived experience, that more psychotic phenomena than previously thought can be rendered at least somewhat intelligible. Besides bizarre experiences like illusions, hallucinations and intense feelings of significance, I also explain what it is like to lose one’s bedrock, and how this loss impacts which beliefs one has reason to reject. Finally, I give an inside account of some disturbances of reason, and show that there are important similarities between certain psychotic reasoning problems and common non-pathological phenomena. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

In this paper I put forward a view of the drug-related desires experienced by addicted agents ―‘addictive desires’, for short. On my account, the most remarkable feature of these desires is not that they ‘push’ the agent with a force she cannot oppose, but that they constitute an unusually stubborn source of motivation. Addictive desires are unordinary, in part, in that they are a persistent source of influence over decision-making processes that is not easily undermined by factors that normally have (...) the ability of undermining desires, with the result that addicted individuals experience episodes of occurrently wanting to use drugs that recur with tremendous frequency. Both these features ―their unusually high degrees of recalcitrance and recurrence― contribute to a decrease in reasons-responsiveness when it comes to matters related with drug use. While the difference with ordinary, non-addictive desires in both these regards is a matter of degree, it comes down to a highly significant difference nonetheless. (shrink)

The diverse essays in this volume speak to the relevance of phenomenological and psychological questioning regarding perceptions of the human. This designation, human, can be used beyond the mere identification of a species to underwrite exclusion, denigration, dehumanization and demonization, and to set up a pervasive opposition in Othering all deemed inhuman, nonhuman, or posthuman. As alerted to by Merleau-Ponty, one crucial key for a deeper understanding of these issues is consideration of the nature and scope of perception. Perception defines (...) the world of the perceiver, and perceptual capacities are constituted in engagement with the world – there is co-determination. Moreover, the distinct phenomenology of perception in the spectatorial mode in contrast to the reciprocal mode, deepens the intersubjective and ethical dimensions of such investigations. -/- Questions motivating the essays include: Can objectification and an inhuman gaze serve positive ends? If so, under what constraints and conditions? How is an inhuman gaze achieved and at what cost? How might the emerging insights of the role of perception into our interdependencies and essential sociality from various domains challenge not only theoretical frameworks, but also the practices and institutions of science, medicine, psychiatry and justice? What can we learn from atypical social cognition, psychopathology and animal cognition? Could distortions within the gazer’s emotional responsiveness and habituated aspects of social interaction play a role in the emergence of an inhuman gaze? -/- Perception and the Inhuman Gaze will interest scholars and advanced students working in phenomenology, philosophy of mind, psychology, psychiatry, sociology and social cognition. -/- Table of Contents -/- Introduction -/- Part I. The Gaze in Classical Phenomenology: Perspectives on Objectification -/- 1. Defending the Objective Gaze as a Self-transcending Capacity of Human Subjects -/- Dermot Moran -/- 2. Two Orders of Bodily Objectification: The Look and the Touch -/- Sara Heinämaa -/- 3. On Eliminativism’s Transient Gaze -/- Timothy Mooney -/- 4. Not wholly human. Reading Maurice Merleau-Ponty with Jacques Lacan. -/- Dorothée Legrand -/- 5. Disclosure and the Gendered Gaze in Simone de Beauvoir's Ethics -/- Christinia Landry -/- Part II. Vision, Perception and Gazes -/- 6. Inside the gaze -/- Shaun Gallagher -/- 7. Perception and its Objects. -/- Maurita Harney -/- 8. Technological Gaze: Understanding How Technologies Transform Perception -/- Richard Lewis -/- 9. The Inhuman Gaze and Perceptual Gestalts: The Making and Unmaking of Others and Worlds -/- Anya Daly -/- Part III. Psychiatry, Psychopathology and Inhuman Gazes -/- 10. Values and Values-based Practice in Psychopathology: Combining Analytic and Phenomenological Approaches -/- G Stanghellini and K.W.M. (Bill) Fulford -/- 11. The Inhuman and Human Gaze in Psychiatry, Psychopathology and Schizophrenia. -/- Matthew Broome -/- 12. Overcoming the Gaze: Psychopathology, Affect, and Narrative. -/- Anna Bortolan -/- 13. From excess to exhaustion : The rise of burnout in a post-modern achievement society. -/- Philippe Wuyts -/- 14. Blackout Rages: The Inhibition of Episodic Memory in Extreme Berserker Episodes -/- John Protevi -/- Part IV. Beyond the Human: Divine, Posthuman and Animal Gazes -/- 15. Wondering at the Inhuman Gaze -/- Sean. D. Kelly -/- 16. What Counts as Human/ Inhuman Right Now? -/- Rosi Braidotti -/- 17. Beyond Human and Animal: Metamorphosis in Merleau-Ponty -/- Dylan Trigg -/- Part V. Sociality and Boundaries of the Human -/- 18. Voice and gaze considered together in ‘languaging’. -/- Fred Cummins -/- 19. Ethics Beyond the Human: Disability and The Inhuman -/- Jonathan Mitchell -/- 20. Social Invisibility and Emotional Blindness -/- James Jardine -/- 21. What are you looking at? Dissonance as a window on the autonomy of participatory sense-making frames. -/- Mark James. (shrink)

This thesis is a philosophical examination of the explanatory roles of diagnoses in psychiatry. In medicine, diagnoses normally serve as causal explanations of patients’ symptoms. Given that psychiatry is a discipline whose practice is shaped by medical traditions, it is often implied that its diagnoses also serve such explanatory functions. This is evident in clinical texts that portray psychiatric diagnoses as referring to diseases that cause symptoms. However, there are problems which cast doubt on whether such portrayals are justified. I (...) address these problems and examine whether psychiatric diagnoses provide explanations of symptoms. The first problem is conceptual. In diagnostic manuals, psychiatric diagnoses are defined by their symptoms. This suggests that invoking them as explanations of the symptoms amounts to circularity. I argue that this can be resolved with an appropriate conceptual framework that captures the complex semantic values of diagnostic terms and their different uses in clinical discourse. I put forward such a framework based on two-dimensional semantics. The second problem is ontological. Empirical research suggests that diagnostic categories in psychiatry do not correspond to invariant causal types, but are associated with variable combinations of diverse causes that interact across biological, psychological, and social levels. Given this heterogeneity, I argue that psychiatric diagnoses fall short of paradigmatic cases of causal explanation, but that some can still provide other sorts of useful causal explanatory information. The original contribution of this thesis is the illumination of the conceptual relations between diagnoses and symptoms. This philosophical work is important, because it can be brought to valuable application in modifying psychiatric practice. (shrink)

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether the functions (...) of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

Musing for Puncta special issue "Critically Sick: New Phenomenologies Of Illness, Madness, And Disability.".

The experiences described in the VIP transcripts are incredibly varied and yet frequently explicitly labelled by participants as "voices." How can we make sense of this? If we reflect carefully on uses of the word "voice", we see that it can express at least two entirely different concepts, which pick out categorically different phenomena. One concept picks out a speech sound (e.g. "This synthesizer has a "voice" setting"). Another concept picks out a specific agent (e.g. "I hear two voices: one (...) is a ten year-old boy…"). This chapter explores how these two concepts are related to one another in the context of voice-hearing. (shrink)

Approaching mental health on a global scale with particular reference to low- and mid-income countries raises issues concerning the disregard of the local context and values and the imposition of values characteristic of the Global North. Seeking a philosophical viewpoint to surmount these problems, the present paper argues for a value-laden framework for psychiatry with the specific incorporation of value pluralism, particularly in relation to the Global South context, while also emphasizing personal values such as the choice of treatment. In (...) sketching out this framework, the paper aims to overcome the clash between universalism and relativism about psychiatric categories by focusing on how overlaps between cultures can contribute to ontology-building. A case study analyzing ethnopsychiatric research in the context of South India will illustrate the proposed view, while also pointing out avenues for further research on the causal efficacy of local shared beliefs about mental disorder. If approaches across different traditions and theoretical frames are shown to work in treating similar ailments, causal connections appear to cut across the different ontologies. Ethnopsychiatry would play a central role in such research, namely in disclosing the variables and mechanisms at work within the local approaches. (shrink)

An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that traumatic events can be converted (...) into deviant behaviour – these neurologists use the term functional neurological disorder and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability. (shrink)

According to several researchers, core affect lies at the foundation of our affective lives and may be characterized as a consciously accessible state combining arousal (activated-deactivated) and valence (pleasure-displeasure). The interaction between these two dimensions is still a matter of debate. In this paper we provide a novel hypothesis concerning their interaction, by arguing that subjective arousal levels modulate the experience of a stimulus’ affective quality. All things being equal, the higher the arousal, the more a given stimulus would be (...) experienced as pleasant (or unpleasant). While marshaling some preliminary evidence in favor of this hypothesis, we also show how it might be relevant in reframing our conception of depressive disorders (i.e., major and bipolar depression). (shrink)

The provocative paper by John Forrester ‘If p, Then What? Thinking in Cases’ opened up the question of case thinking as a separate mode of reasoning in the sciences. Case-based reasoning is certainly endemic across a number of sciences, but it has looked different according to where it has been found. This article investigates this mode of science – namely thinking in cases – by questioning the different interpretations of ‘If p?’ and exploring the different interpretative responses of what follows (...) in ‘Then What?’. The aim is to characterize how ‘reasoning in, within, with, and from cases’ forms a mode of scientific investigation for single cases, for runs of cases, and for comparative cases, drawing on materials from a range of different fields in which case-based reasoning appears. (shrink)

Epistemic akrasia is the phenomenon of voluntarily believing what you think you should not. Whether epistemic akrasia is possible is a matter of controversy. I argue that at least some people who suffer from obsessive–compulsive disorder are genuinely epistemically akratic. I advance an account of epistemic akrasia that explains the clinical data and provides broader insight into the nature of doxastic attitude‐formation.

Though the divide between reason-based and causal-explanatory approaches in psychiatry and psychopathology is old and deeply rooted, current trends involving multi-factorial explanatory models and evidence-based approaches to interpersonal psychotherapy, show that it has already been implicitly bridged. These trends require a philosophical reconsideration of how reasons can be causes. This paper contributes to that trajectory by arguing that Donald Davidson’s classic paradigm of 1963 is still a valid option.

The pathologization of women’s depression covers over the social and institutional causes of that symptomology. Insofar as patriarchal values continue to devalue and debase women and mothers in ways that colonize psychic space, and depression becomes a cover for what I call ‘social melancholy.’ This is not the melancholy of traditional psychoanalysis, but a form of melancholy that results from oppression, domination, and the colonization of psychic space. Social melancholy differs from both Freud’s notion of melancholy in that it is (...) the result of social factors that constitute the depressed subject as ashamed and lacking agency. Crucial to my analysis is a distinction between shame and guilt missing from traditional psychoanalytic accounts of melancholy and depression. (shrink)

THE TARGET OF ERICA LILLELEHT'S interesting comparison between 19th-century moral treatment and 20th-century psychiatric rehabilitation is contemporary psychiatric rehabilitation. Using Foucault's (1979) Discipline and Punish as her critical foil, she argues that psychiatric rehabilitation is "an approach to madness fraught with paradox." The paradox lies in the fact that the techniques of psychiatric rehabilitation can be practiced in a manner that contradicts its professed humanitarian intentions; notably, liberating the mad from "resource dependency and segregated living." The lesson to be drawn (...) from this paradox is that "our practices, may be shaped and reformulated to serve goals of which we are only dimly aware." The resulting "mindfulness" is supposed to make us more careful and critical of what to count as success and progress in psychiatric treatment. (shrink)